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Immediate Reconstruction of the Radiated Breast: Recent Trends Contrary to Traditional Standards

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Immediate, implant-only breast reconstruction is traditionally discouraged in patients who receive radiation. It is not clear whether this widely recognized mantra of breast reconstruction is observed in practice. The purpose of this study was to evaluate immediate reconstruction trends and practices in patients who have undergone mastectomy and radiation therapy.

Methods

Female patients with unilateral breast cancer who required radiation in addition to mastectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Patients who underwent immediate reconstruction were identified and analyzed. Univariate and logistic regression analyses were performed to study the relationship between reconstructive method and patient demographic and oncologic characteristics.

Results

A total of 5,481 female patients who underwent radiation and breast reconstruction were included for analysis. Postmastectomy radiation therapy was performed in 98.3 % of the patients. The immediate breast reconstruction rate among patients requiring radiation increased from 13.6 to 25.1 %. The percentage of reconstructed patients who had implant-only reconstruction increased from 27 to 52 % (p < 0.001) with a decrease in tissue-only reconstruction from 56 to 32 % (p < 0.001). In regression analysis, the odds of implant reconstruction over autologous reconstruction increased each year by an odds ratio of 1.13 (95 % CI 1.10–1.15).

Conclusions

The frequency of immediate reconstruction continues to increase in the setting of postmastectomy radiation therapy, with immediate implant-based reconstruction representing the most commonly utilized method, contrary to traditional recommendations. These findings likely reflect changing attitudes towards implant reconstruction in the setting of planned postmastectomy radiation.

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Acknowledgment

Support for this study was provided in part by grants from the Plastic Surgery Foundation (to A.O.M.) and by a Midcareer Investigator Award in Patient-Oriented Research (2K24 AR053120-06) (to K.C.C.).

Disclosures

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

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Authors and Affiliations

  1. Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA

    Shailesh Agarwal MD, Aaron Farberg MD, Jeffrey H. Kozlow MD, MS, Kevin C. Chung MD, MS & Adeyiza O. Momoh MD

  2. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Kelley M. Kidwell PhD

Authors
  1. Shailesh Agarwal MD
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  2. Kelley M. Kidwell PhD
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  3. Aaron Farberg MD
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  4. Jeffrey H. Kozlow MD, MS
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  5. Kevin C. Chung MD, MS
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  6. Adeyiza O. Momoh MD
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Correspondence to Adeyiza O. Momoh MD.

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Agarwal, S., Kidwell, K.M., Farberg, A. et al. Immediate Reconstruction of the Radiated Breast: Recent Trends Contrary to Traditional Standards. Ann Surg Oncol 22, 2551–2559 (2015). https://doi.org/10.1245/s10434-014-4326-x

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  • DOI: https://doi.org/10.1245/s10434-014-4326-x

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